wear off effect of Prozac and oterh SSRIs

[j8]

I took Prozac for mild OCD & PMS at increasing doses for 8 years until I learned that SSRI effectiveness eventually stops.  Please confirm - does this apply to all SSRIs?  Does a person use a drug in increasing doses until effectiveness is lost, then wean off & begin a new one?  I may ask my doctor about Lexapro, but first want to know if:
1. will it wear off too?
2. How long does it take to kick in (is 4-6 weeks the norm for all SSRIs)?  
3. Do I have to wean of St John's Wort first?
4. Can I take 5 HTP at the same time?  
I don't feel like I can get all these answers from my doctor.
Thanks!!

[Roger Gould, M.D.]

After awhile all medications like this seem to lose some of their effects, partly because life circumstances change, and their is a breakthrough effect. Yes, going off Prozac is normally 4-6 weeks, but if you start Lexapro, you can go off much faster as you gradually increase the Lexapro.  The same is true for St. John's Wort. I would not complicate matters with 5htp.

[ontherecord]

Common sense would dictate that all SSRI's would have the same effect on all people, since they all do the same thing: they inhibit the reuptake of serotonin.  What surprises me, and what seems against logic, is that some people fail to respond to Paxil but may respond to Zoloft.  Some may not be able to tolerate Prozac but find that Celexa works well for them.  Therefore, given the reality of the matter, it seems like Lexapro may be worth a shot, especially since you benefit from Prozac for all these years.  Will Lexapro wear off in time? Maybe, maybe not...but if you can get 5 years from Lexapro, but then there will be more antidepressants on the market, some better than the ones today....

so,

1. Try Lexapro and don't worry about the long-term loss of effectiveness.  No way to tell.  First we need to see if Lexapro does work.  Since Lexapro is an SSRI, you don't have to worry about withdrawal from Prozac.

2.  It takes 2-4 weeks, not 4-6, but it could take 6 weeks before you feel the full therapeutic effect.  Start with 10mg of Lexapro and up to 20mg as your doctor indicates.

3. Don't mix St. Johns Wort with SSRI's.  They may have additive effects and may cause lightheadedness or dizziness.  Not recommended.

4. I'm not sure what 5HTP is exactly, but it's best to avoid OTC herbal remedies while you're on antidepressants.  Of course you should always take a multivitain and b-complex.

Good luck to you.

[j8]

hi - thanks for your comments.  Here's a question: do SSRIs "train" your system to need them?  I don't mean are they addictive.  Rather, has my system become used to them, and therefore I am even more likely to need them long term?

Isn't it amazing how often the answers just don't seem to exist in the published reports and lit?  
thx

[ontherecord]

Sure, the brain adjusts to the increased levels of serotonin and once a person discontinues, the pretreatment depression comes back, usually even worse than before.  That's why most people who try to discontinue often find themselves starting it up again or just being depressed.  Not only that, the withdrawal symptoms, in and of themselves, exacerbate depression and anxiety.  

The literature fails to mention all of this stuff because it can't be empirically proved.  Doctors acknowledge that benzodiazepines are physically addictive, in the true sense of the word, but I'd say that antidepressants are also "addictive" in a different sense.  And most of this goes unsaid for two reasons: first, antidepressants are a BIG business, and very very profitable for all involved.  Second, if psychiatrists didn't push the pills aggressively, how would they be any different from psychologists or social workers? Psychiatrists have a vested interest in prescribing medications as well.  The more often they prescribe different medications to different people, the more they learn about the profile (risks, side effcts, benefits) of each medication.  Notice how when a new drug is released, most doctors are quick to prescribe it, so they can determine how well it works.  And patients are also culpable to some degree.  Medications, more often than not, are a good crutch and help people become more resilient and more functioning.

[j8]

uhg.  Well...I believe you've hit the mark.  My brain thinks it needs more serotonin than I ever did in the beginning, and my life without the med is exacerbating the effect of my root issues (the identity of which I don't know - I'm pretty happy when I'm not miserable :).  I went off Prozac last Oct & have made serious efforts to improve without returning to a drug.  (No sugar, no caffeine, serotonin diet, all the right vitamins, yoga, and finally St JW for 2 mos, and I have always exercised regularly.)  My tentative plan is to commit to therapy for a year, and use a TINY dose of Lexapro if I can tolerate it.  Then hopefully I can shrink the tiny dose to a miniscule one, then an intermittent miniscule one, then nada.  oh my.  How did I get here?

Have you ever taken Lexapro?

[ontherecord]

HA! very interesting to read your post I applaud your intensive efforts.  I haven't used Lexapro.  The starting dose and the dose that works for most people is 10mg; if that works for you then you could reduce to 5mg and see how that goes.  I hear it's pretty good and am thinking of trying it out myself.  Right now I am on Effexor XR -- a relatively moderate dose -- and it hasn't shown much improvement.  I'm going to max out my Effexor XR, see how that goes and then my next step is Lexapro, then Lexapro supplemented with Wellbutrin if Lexapro doesn't work alone.  

If you find that these meds help your mood, there really isn't anything bad about taking them long-term, except the expense and the hassle of getting the scripts refilled.  When I get depressed, I drink.  And I'd much rather be on an antidepressant and not drink than not be on an antidepressant and drink.  So for me, it's the lesser of two evils.

[j8]

Your logic makes sense to me; as long as the meds aren't going to make us increasing dependent on them we should take advantage of them.   In the big pic, they can't possibly be as bad as living a lesser life, eg. drinking or whatever your negatives are, ya know? HOWever...reality says we gotta use them as a booster to get us through the WORK of being better long term - don't you think?  (Sheesh - listen to me.  Wait until 2mrw or the next and I'll be whining about how I just want to feel better, rather than being gung ho about working to get there.)  

[ontherecord]

I don't believe in therapy.  I've tried it and it's a waste of time frankly.  When I was in school, it was free, and I still thought it was a waste.  I'd never, ever pay a dime to a social worker or a psychologist for the b.s. they spew daily.  Not even worth a penny.  Therapists try to change the way you see things, but you and I both know how we *should* see things; if we could implement that ourselves, we wouldn't need therapy.  It's because we can't modulate our feelings and change our own outlooks that we resort to medications.  No therapist ever helped me put the bottle down.  But when I'm on a good antidepressant combined with a mild dose of benzodiazepine, I don't feel the urge to even touch the stuff.  Not only that, I feel more resilient, more assertive and more energetic on certain medications.  The sex drive goes down with a lot of these medications, but again, it's the lesser of two evils.

I say stick with the pill.  It's got its downsides, but after a long assessment of the benefits against the risks, I think staying on them is the smart thing for me to do.  I don't have major depression.  I have dysthymia -- a chronic, low-grade form of depression that I've had since 16 (I'm 26 now); it's never going to go away on it's own.  Even when things in life are going well, and I'm accomplishing the things I need to, I still feel it at times.

[j8]

I guess I know what you mean.  I'm always saying how I have absolutely no reason to feel anything but happy - so why don't I?
It's a good argument pro-meds.  I do plan to do the counseling bit too, since I never bothered to stay with it for more than a month...to some extent, one should be able to "train" ones mind to think a certain way, just as we might train our muscles to perform a certain way; I want to try that with the couseling.  But I know I can't completely change the way my system works - hence the need for meds.  Wish me luck with both!  To your credit, you're very realistic and sensible about what you've been through - I think that's much of the battle.  The alternative is a constant search for an answer...with no end to it.  At least not in this year's medical world.  I see the doc today for the Lex.  Fingers crossed....

[platinum]

I am always encouraged when I read your posts.  You seem to have great knowledge and a "positive" attitude towards your plight.  I have been given Lexapro for depression/mild ocd (peaks) but have chosen not to take it because I plan to do it on my own.  It's harder without meds but I know I have it just in case I "need" it.  I am trying to stay positive and reading your posts helps me GREATLY.  I thought that you had been in "therapy" but see that we both share the same views.  Never been and plan (hope) not to go.   I check the forums daily.  I feel the more you know the better and alot of people have been through alot and keep on going and that is what drives me to be able to do the same and to also know that I am not the only one.  I wish you much success.

[ontherecord]

Thank you very much.  I wish you much success as well.  Although I was never diagnosed as such, I think I have mild OCD (and I think many people suffering from depression and anxiety have it to some degree, some more than others).  I think we can both agree that working through OCD tendencies is a very tough thing indeed.  In my opinion, "OCD" should be broken down into two discorders: obsessions on one hand, and compulsions on the other hand.  The two things are very different and discrete disorders from the way I see it.  The former entails excessive worrying/apprehension with unwanted *thoughts* while the other, from my understanding, entails repetitive behavior that a person must engage in (like repeated handwashing).  Unfortunately, the DSM-IV criteria doesn't draw these naunced disctinctions and I think each one would warrant separate treatment.  

If you do start the Lexapro, let us know how it turns out for you.  I've read that it's generally an effective antidepressant that is well tolerated and quick to act (1-2 weeks) with a low rate of discontinuation.  Just rememeber though, although it is good that you're trying to work out these things on your own, the meds, should you decide to take them, will take some time to kick in.  Again, good luck to you as well.

[ontherecord]

You know what works extraodinarily well from my experience: those Zen medidation/way of life books.  Zen, Confucious, Taosim and some of the other far eastern disciplines.  I've read some of those books, and they provide a truly *different* way to look at life and its challenges.  It really is remarkable.  Many of the suggestions within these books (which aren't written for commercial gain, like the books we see in any self-help section of the bookstore) encourage looking within yourself and leveraging your own inner resources (and they are there, albeit sometimes dormant) and harnessing those resources harmoniously with the world around you.  These disciplines stress patience and acceptance.  You should check out some of these books, I think you'd benefit from their unique inside-looking perspective on things.  Of note, is that depression and anxiety (and social isolation and addictive behavior) are far less prevelant in those far eastern countries than they are here in the U.S.  Many of these disciplines are more than religions -- they are a way of life.  If you've ever see the movie The Last Samurai, with Tom Cruise, you'll know what I'm talking about.  Most religions stress blind devotion to whatever god you believe in, but surprisingly these far eastern religions offer a way of life.  Not suggesting you convert, just suggesting that some of the principles have given me perspective in my own life.....

Let us know how that appointment goes.

[platinum]

I was given the Lex about a month and half ago and so far so good (as far as not taking them).  After much research, I discovered that I was already doing alot the techniques that therapy encourages to move past the obsessions.  I agree with you that OCD is two different things because I have the unwanted thoughts (spikes) but I don't have the compulsive part.  I was very afraid at first because the thoughts were disturbing in nature but I talked myself thru them simply because I was tired of them and even got mad with them.  It works with panic attacks as well.  I talk myself thru them because "there is nothing to fear but fear itself".  I can see how people would bow down to them and give in but I have too many responsibilites to deal with which ironically is why I probably have them (what a cycle).  I'm sure somewhere down the road we will cross paths again.  Wishing you well.

[j8]

Am curious now to check out some of the schools of thought you reference (which I haven't seriously considered since a world religion sem in college).  I've begun to try yoga, which is such a holistic exercise - or more aptly, a "practice" as it's known.  Something along those lines but deeper may be an excellent addition to my overall prescription.  So thx for the suggestion.  I'll try anything to get a tighter grip on my thought processes (once negative thoughts get some momentum, they're beasts).  You've helped me feel quite comfortable with my low-dose Lex approach (I start 2nite), and I will keep you posted.  My doc echoed you; taking meds is no big deal if it helps you live a better life.  At this point, all I really want is to be able to spend less of my time thinking about my issues, and more of my time living my life - ya know?!  I'll catch ya here in a week or something.  Peace.

[tough-going]

Well this is the first time I've ever signed up for a discussion board, but the topic was one I'm familiar with.
I too have tried many antidepressants (am back to zoloft with a side of wellbutrin), and also don't have much interest in therapy because I KNOW what I should be doing.  It's the doing it that's practically impossible for me.
I think yoga is a great thing to try.  I tried Pilates.  It just wasn't for me because I'm a bit hyper.  What I've ended up with is Tai Chi.  Not just the "wellness" TC, I take from a Kung Fu school and am learning a lot of self defense too.  It's providing me with the meditative stuff I need (but can't sit for) at the same time giving me some exercise.  Just thought I'd add that to the list of possibilities.

[ontherecord]

Yoga sounds great.  It works for so many people and it's caught on like wildfire in most health clubs, so I think you're on to something there....

As for the Lexapro, if you're on 10mg as I suspect, I'd be curious to know how it works for you.  I've read that it kicks in quicker than some of the other SSRI's, but you can be the judge of that.  I upped my dose of Effexor to 225mg, and I'll also let you know how that turns out:) Be well.

[dolcie]

just started lexapro about three weeks ago, and after the first two weeks it has been smooth sailing.  i have seen a better control of thought process and a more mellow attitude towards others.  So far so good...

[ontherecord]

Are you in 10mgs? How are the side effects?

[j8]

hi - in case you check in - thought i'd advise thigns are going well.  have been on Lex, 5 mg once a day, for 3 or 4 weeks now. zero side effects (not even dry mouth) and feeling much better. my worst issues were:
*extreme irritation nearing rage during certain days of cycle - those are gone.
*very hopeless other times during cycle - every negative piece of my life felt devastating and un-fixable.  those moments are gone.

Nowadays, i still have mo's during which i'm sad or i can't get mys thoughts off a negative slant, but there of less of such moments and they go away faster.  frankly - i think they're what we might call normal.  i'm hoping that lex will get rid of the extreme serotonin related moments, and now i just have to adjust to accepting the highs and lows of normal life.  we can't ask
for too much, right?

the lex works better for me in the morning than at night.  i get the full benefit in the early part of the workday, when I'm most liekly to be bumming (my job is dull).

fyi!!